This application for an NIMH Mentored Clinical Scientist Development Award (MCSDA) using the K-08 mechanism is entitled: "PTSD and non-adherence in pediatric transplant patients." The purpose of this proposal is to examine symptoms of Posttraumatic Stress Disorder (PTSD) in pediatric transplant recipients, and to investigate their relationship with non-adherence to medications and poor medical outcome. Non-adherence in pediatric transplant recipients is common and potentially fatal. Hence, it is important to study risk factors (such as PTSD) that may inform treatment options for this behavior. Symptoms of PTSD can develop in children who survive solid organ (e.g., liver) transplantation. Such children may become non-adherent with their transplant medications. The medication may be perceived as a reminder of the traumatic event (the medical illness or the transplant) and hence avoided. The goal of this proposal is to examine the relationship between non-adherence, psychosocial risk factors, PTSD, and medical outcome in pediatric transplant recipients so as to determine whether PTSD is associated with non-adherence and poor outcome. To achieve this goal, the principal investigator will work with the mentor and the consultants who will provide expertise related to the research aims of this proposal. The principal investigator will perform a prospective, longitudinal study of pediatric transplant recipients who will be evaluated semiannually during the award period. The evaluation will include psychiatric measures as well as medical outcome data and adherence assessments. At year 4 of the MSCDA, the data will be analyzed and associations between PTSD, risk factors, medical outcome and non-adherence will be examined. The results of the research component and the knowledge gained through the teaching component of the MCSDA will inform future intervention research targeting posttraumatic symptoms in pediatric transplant recipients for the purpose of improving adherence to medications as well as medical and psychiatric outcome. This proposal will therefore allow the principal investigator to develop into an independent investigator performing clinical research into the phenomenology and treatment of co-morbid psychiatric and medical illness in children.